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WAC 182-553-300

Home infusion therapy/parenteral nutrition program—Client eligibility and assignment.

(1) To receive home infusion therapy and parenteral nutrition, subject to the limitations and restrictions in this section and other applicable WAC, a person must be eligible for one of the Washington apple health programs listed in the table in WAC 182-501-0060.
(2) Persons enrolled in an agency-contracted managed care organization (MCO) are eligible for home infusion therapy and parenteral nutrition through that plan.
(3) Persons eligible for home health program services may receive home infusion related services according to WAC 182-551-2000 through 182-551-3000.
(4) To receive home infusion therapy, a person must:
(a) Have a written physician order for all solutions and medications to be administered.
(b) Be able to manage their infusion in one of the following ways:
(i) Independently;
(ii) With a volunteer caregiver who can manage the infusion; or
(iii) By choosing to self-direct the infusion with a paid caregiver (see WAC 388-71-0580).
(c) Be clinically stable and have a condition that does not warrant hospitalization.
(d) Agree to comply with the protocol established by the infusion therapy provider for home infusions. If the person is not able to comply, the person's caregiver may comply.
(e) Consent, if necessary, to receive solutions and medications administered in the home through intravenous, enteral, epidural, subcutaneous, or intrathecal routes. If the person is not able to consent, the person's legal representative may consent.
(f) Reside in a residence that has adequate accommodations for administering infusion therapy including:
(i) Running water;
(ii) Electricity;
(iii) Telephone access; and
(iv) Receptacles for proper storage and disposal of drugs and drug products.
(5) To receive parenteral nutrition, a person must meet the conditions in subsection (4) of this section and:
(a) Have one of the following that prevents oral or enteral intake to meet the person's nutritional needs:
(i) Hyperemesis gravidarum; or
(ii) An impairment involving the gastrointestinal tract that lasts three months or longer.
(b) Be unresponsive to medical interventions other than parenteral nutrition; and
(c) Be unable to maintain weight or strength.
(6) A person who has a functioning gastrointestinal tract is not eligible for parenteral nutrition program services when the need for parenteral nutrition is only due to:
(a) A swallowing disorder;
(b) Gastrointestinal defect that is not permanent unless the person meets the criteria in subsection (7) of this section;
(c) A psychological disorder (such as depression) that impairs food intake;
(d) A cognitive disorder (such as dementia) that impairs food intake;
(e) A physical disorder (such as cardiac or respiratory disease) that impairs food intake;
(f) A side effect of medication; or
(g) Renal failure or dialysis, or both.
(7) A person with a gastrointestinal impairment that is expected to last less than three months is eligible for parenteral nutrition only if:
(a) The person's physician or appropriate medical provider has documented in the person's medical record the gastrointestinal impairment is expected to last less than three months;
(b) The person meets all the criteria in subsection (4) of this section;
(c) The person has a written physician order that documents the person is unable to receive oral or tube feedings; and
(d) It is medically necessary for the gastrointestinal tract to be totally nonfunctional for a period of time.
(8) A person is eligible to receive intradialytic parenteral nutrition (IDPN) solutions when:
(a) The parenteral nutrition is not solely supplemental to deficiencies caused by dialysis; and
(b) The person meets the criteria in subsection (4) and (5) of this section and other applicable WAC.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148). WSR 14-07-042, § 182-553-300, filed 3/12/14, effective 4/12/14. WSR 11-14-075, recodified as § 182-553-300, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-553-300, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090, 74.09.530. WSR 04-11-007, § 388-553-300, filed 5/5/04, effective 6/5/04.]
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